WELCOME

ROLE OF A NURSE IN
DISASTER
MANAGEMENT

Dr.Nilima Sonawane
M Sc Nursing ,MPhil
Phd (Nursing)
NURSES AND EDUCATION

 Education is the most powerful

weapon which you can use to change
the world.
Nelson Mandela
MISSION STATEMENT

 A disaster is a catastrophic incident that

commonly leads to immense damage and
devastation. Whether the cause of the event is
natural or man-made, the outcomes can be
shocking. Preparedness is one of the major
components of disaster response. Nurses
comprise the largest healthcare workforce and
are working at the frontline of the healthcare
response to disasters, thus their capacity
building can be achieved by training and skill
development.
LECTURE OUTLINE

1. Definition of disaster
2. Phases of disasters
3. Impact of disaster on health and the health
services
4. Community participation in disaster
management.
5. Role of nursing professionals in various phases
of disasters.
DISASTER

 Disaster is any occurrence that causes damage,

ecological disruption, loss of human life or
deterioration of health and health services on a scale
sufficient to warrant an extraordinary response from
outside the affected community or area.

(WHO 1995)
TYPES

 Natural

 Man made

 Mixed
MAN-MADE VS NATURAL DISASTER
Unpredictable
Unexpected
Disruptive
Target
Dangerous
Casualties focused
Difficult to management
Sentiment and feeling
Never ending
DISASTER AGENT
 Primary agents include falling buildings, heat, wind, rising
water and smoke.
 Secondary agents include bacteria and viruses that produce
contamination or infection after the primary agent has caused
injury or destruction.

HOST
 Human kind.
 Age, sex, immunization status, pre-existing health, degree of
mobility, emotional stability,
ENVIRONMENT

 PHYSICAL FACTORS

 CHEMICAL FACTOR

 BIOLOGICAL FACTORS

 SOCIAL FACTORS

 PSYCHOLOGICAL FACTORS
PHASES OF THE DISASTER
DISASTER MITIGATION
Disaster mitigation refers to actions or measures
that can either prevent the occurrence of a
disaster or reduce the severity of its effects.
(American Red Cross).

 Mitigation activities include awareness and

education and disaster prevention measures.
 Activities that reduce or eliminate a hazard
 Prevention
 Risk reduction
 Examples
 Immunization programs
 Public education
DISASTER PREPAREDNESS

 Disaster preparedness refers to measures taken

to prepare for and reduce the effects of disasters.
That is, to predict and, where possible,
prevent disasters, mitigate their impact on
vulnerable populations, and respond to and
effectively cope with their consequences.

International Red Cross

DISASTER PREPAREDNESS

Activities undertaken to handle a disaster when it

strikes.

 Activities
 Disaster Preparedness Plan
 Emergency communication plan
 Prevent spread of disease outbreak
 Public Education and awareness
 DISASTER IMPACT AND RESPONSE

 Activities a hospital, healthcare

system, or public health agency
take immediately before, during,
and after a disaster or emergency
occurs.

 Search , rescue and first aid ,field

care , triage activation , referral
services clearing debris, and
feeding and sheltering victims .
DISASTER RECOVERY ,
RECONSTRUCTION AND
REHABILITATION
 Getting a community back to its pre-disaster
status

 Activities
 Debris Removal
 Care and Shelter
 Damage Assessments
 Funding Assistance
 Emotional care
 IMPACT OF
DISASTERS

 Death
 Severe injuries requiring extensive treatment

 Increase risk of communicable diseases and

epidemics outbreak
 Excess NCD mortality

 Mental health (disaster syndrome)

 The destruction of the health care

infrastructure,
 Damage water supply and basic sanitation

 Food shortage and Malnutrition

 Population movement and migration

THE MOST VULNERABLE
DISASTER MANAGEMENT

It can he defined as the

effective organization direction
and utilization of available
counter-disaster resources
PRINCIPLES OF DISASTER MANAGEMENT
(GRAB AND ENG 1995)
 Prevent the occurrence of the disaster whenever
possible.
 Minimize the number of casualties if the disaster
cannot be prevented.
 Prevent further casualties from occurring after the
initial impact of the disaster.
 Rescue the victims.

 Provide first aid

 Evacuate the injured to medical facilities.

 Provide definitive medical care.

 Promote reconstruction of lives.

DISASTER PREPAREDNESS

 Aims of disaster plans

 To provide prompt and effective medical care to
the maximum possible in order to minimize
morbidity and mortality.

 Objectives
 To optimally prepare the staff and institutional 
resources for effective performance in disaster
situation.
 To make the community aware of the sequential
steps that could be taken at individual and
organizational levels.
DISASTER MANAGEMENT
COMMITTEE
 Chairman , Medical superintendent/ Director
 Additional Medical Superintendent

 Nursing Superintendent/ Chief Nursing Officer

 Chief medical officer (casualty)

 Head of departments- surgery, medicine,

orthopedics, radiology, anesthesiology,
neurosurgery
 Blood bank in charge

 Security officers

 Transport officer

 Sanitary personnel
 MULTIDISCIPLINARY DISASTER
MANAGEMENT TEAM

Chaplains Physician, Surgeon,

Nurses
Orthopedics

Multi-Disciplinary Team
Fire, Police, Politician, Multi-Disciplinary
Team Psychiatrist
Safety Officer, BMC.

Para-Professional Psychologist
Social
worker,
NGOs.
QUALITIES OF A NURSE WORKING IN
DISASTERS

Confidence
•Cooperation
•Commitment
•Coordination
•Control
•Value of human life
•Gentleness and devotion
•Strength
•Trust
•Interdependence and Team spirit
•Accept Self criticism
•Toughness & Sensitivity
•Leadership
•Responsibility and accountability
DISASTER NURSING

Disaster nursing can be defined as the

adaptation of professional nursing skills in
recognizing and meeting the physical, health and
emotional needs of the affected community
resulting from a disasters.

NURSING GOAL

To achieve the best possible level of health for the

people and the community affected by disasters.
ROLE OF NURSING IN DISASTERS

Disaster preparedness, including risk assessment

and multi-disciplinary management strategies at
all system levels, is critical to the delivery of
effective responses to the short, medium, and long-
term health needs of a disaster-stricken
population.

International Council of Nurses (2006)

ROLE OF NURSE IN MITIGATION

Measures designed either to prevent hazards from

causing emergency or to lesson the likely effects of
emergencies .

Community Assessment
knowledge of community resources (e.g., emergency
services, hospitals, and clinics), community health
personnel, community government officials, and local
industry.
DISASTER MITIGATION…

 A structured and logical approach to the

identification and management of risks, will assist
communities to minimize the likelihood or impact
of disasters.

Risk Management

 - Identify Risk
 - Analyze and Evaluate Risk

 - Treat Risk

 - Monitor Risk
 ROLE OF A NUESRE IN MITIGATION

ASSESSMENT AND DIAGNOSIS

 Risk assessment and analysis

 Previous disaster

 local climate conducive to disaster formation.

 The magnitude

 The coping strategies of the locals

 Current community disaster plan

 Health personnel available

 Health Facilities available

 Local agencies and organizations.

ROLE OF A NURSE IN DISASTER MITIGATION

 Diagnose Community Disaster Threats

 Determine actual and potential disaster threats
 Preventive measures is been taken care of
 Is there collabative activites are undertaken
 Are the people aware about
 Community preparedness
ROLE OF A NURSE IN MITIGATION…..

 DIAOGNOSIS
 Diagnose community disaster threats.
 Determine the actual and potential disaster threats.
 effectiveness of Community based disaster plan
 Community awareness
 Community participation
ROLE OF A NURSE IN
MITIGATION….

RISK REDUCTION
 Avoid the risk

 Reduce the likelihood of the

occurrence.
 Reduce the consequences.

 Accept/Retain the risk.

ROLE OF A NURSE IN
DISASTER
PREPAREDNESS

Objectives:-
 To insure the appropriate system procedures &
resources are in place to provide prompt effective
assistance to disaster victims, thus facilitating relief
measure & rehabilitation services.
Elements of disaster plan:
 Chain of authority
 Lines of communication

 Modes of transport

 Mobilization

 Warning

 Equation

 Rescue and recovery

 Triage

 Treatment

 Support of victims and families

 Care of dead bodies

 Disaster worker rehabilitation.

ARE NURSES PREPARED??
 ROLE OF A NURSE IN DISASTER
PREPAREDNESS…

 PERSONAL PREPAREDNESS:
 Capacity Building

 Readiness to work in the multidisciplinary team

 Knowledge about community

 Types of disaster and its management

 Certified first aider and CPR

 Knowledge about Policies and protocols

 Communication skill
PROFESSIONAL PREPAREDNESS:

 Prepared disaster preparedness written plan

 Control room
 Rapid Response Team
 License and health resources
 personal equipment, such as a stethoscope, a flashlight and
extra batteries, Cash, Warm clothing and a heavy jacket (or
weather-appropriate clothing), Record-keeping materials,
Pocket-sized reference books
PROFESSIONAL PREPAREDNESS:
Disaster management committee
Information and communication
Use of personal protective devices
* Disaster beds
* Logistic support system
* Training and drills.
• Unity of command with mobile
van
• Standard operating protocol
 Activation of disaster management plans:
 “Failure to plan is planning to fail”.

 Develop a standard operating procedure

 Reception area-Disaster control room.

 Triage system

 Documentation at control room

 Public relation

 Crowd management
COMMUNITY PREPAREDNESS
 “A prepared community is one which has
developed effective emergency and disaster
management arrangements at the local level,
resulting in :
 - Alert, informed and active community which

 - Supports its voluntary organizations.

 - Active and involved local government.

 - Agreed and coordinated arrangement

EMA – Australian Emergency Manuals Series

 COMMUNITY PREPAREDNESS
• Education
• First aid program
• Making each home to store
• Emergency telephone numbers
• Battery operated radio
• Flash light
• First aid kit
• Three day supply of water
• Medical information &family physician detail
• Persons to be notified in emergency
 
ROLE OF A NURSE IN DISASTER
IMPACT AND RESPONSE

 “Actions taken in anticipation of, during and

immediately after impact to ensure that its
effects are minimized and that people are given
immediate relief and support”.
DISASTER IMPACT
A set of principles which provide a framework
for managing any event.

 􀁺 Command
 􀁺 Control

 􀁺 Coordination

 􀁺 Communication

 􀁺 Clinical Management

 􀁺 Continuity

 􀁺 Capability
 NURSES’ TASK IN
DISASTERS IMPACT

 Determine magnitude of the event

 Define health needs of the affected groups
 Establish priorities
 Identify actual and potential public health
problems
 Determine resources needed to respond
 Collaborate with other professional disciplines,
governmental and non-governmental agencies
 Maintain a unified chain of command
 Communication
ROLE OF A NURSE IN DISASTER
IMPACT AND RESPONSE
 Response to alert:-
 Green :- Additional manpower, less severe
Sudden
 Amber:- Large no. of casualties
 Red: - Major disaster.
 Information to supervisor, prepared mobile van

 Be in multidisciplinary team

 Search , rescue & First Aid

 Distribution of work / delegation of

responsibilities.
 DISASTER IMPACT AND RESPONSE
PHASE
IMPLEMENTATION

 Field care
 Triaging and tagging the victim

 Care for injured persons

 Referral services

 Arranging for physical

facilities for the victim.

Effective communication
TRIAGE : THE BEST STRATEGY
 French verb “trier” means to sort
 Assigns priorities when
resources limited
TRIAGE (CATEGORIZING)
 Red - high priority
 Yellow - medium priority

 Green – ambulatory

 Black – dead
WHY IS DISASTER TRIAGE
NEEDED
Triage consists of rapidly classifying the injured on
the basis of their severity of injuries and likelihood
of their survival with prompt medical interventions.
ADVANTAGES OF TRIAGE
 Helps to bring order and organization to a chaotic
scene.
 It identifies and provides care to those who are in
greatest need
 Helps make the difficult decisions easier

 Assure that resources are used in the most

effective manner
WHO DECIDES IN TRIAGE
 Nurses don’t act for legal fears of being blamed
for deaths, and lack of clarity on where they fit in
the command structure
 Nurses function to the level of their training and
experience.
 If nurses they are the most trained personnel
the site, they are in charge.
TAGGING IN TRIAGE

- Name
 -Age /Sex
 - Place of Origin
 -Triage Category
 - Diagnosis
 - Initial Treatment
ROLE OF A NURSE IN DISASTER
RESPONSE…
 Immediate post disaster intervention:-
 Establish safety.

 Medical Treatment & Nursing Care as Per Need

 Utilization of Available Resources

 Psychological Support

 Life Saving Measures , First Aid

 Evacuation & Supply - Shelter, Food, Water,

Medicine, Communication
 Maintaining Public Moral

 Voluntary Reception, Relatives Waiting Areas

 Management of Infection Control

ROLE OF A NURSE IN DISASTER
RESPONSE..

 Re-riving post disaster stress.

 Encourage ventilation.

 Establishing outreach program to provide

community support.
 Referral services
MENTAL WELLNESS
 In any major disaster, people want to know where
their loved ones are ?

 In case of loss, people need to mourn:

• Give them space,
• Find family friends or local healers to encourage
and support them
• Most are back to normal within 2 weeks
•  About1% to 3%, may need additional help
ROLE OF THE NURSE IN
EMOTIONAL FIRST AID

 Psychiatric disorders:-
 Acute stress reaction

 Post Traumatic Stress Disorders (PTSD)

 Adjustment disorders

 Depressive disorders

 Acute psychosis

 Dissociative disorders

 Anxiety disorders

 Suicides

 Personality changes

 Crises intervention
ROLE OF A NURSE IN EMOTIONAL
FIRST AID
Establish contact
 Taking care of physical needs

 Communicate with them

 Use of drug like sedatives

 Supervision

 Ventilation

 Information meeting

 Re-riving (encouraged to talk about disaster)

 Managing social behavior

MENTAL WELLNESS
 Little attention is paid to the children
 Listen attentively to children without denying
their feelings
 Give easy-to-understand answers to their
questions
 In the shelter, create an environment in which
children can feel safe and secure (e.g. play area)
ROLE OF A NURSE IN RECOVERY ,
REHABILITATION AND RECONSTRUCTION
PHASE

Restoration of the pre –

disaster condition

 Surveillance and prevention of

epidemic outbreak
 Water supply
 Food supply and safety
 Control of vectors
 Care of survivors,
 Vaccination
 Counseling and
 Behavior modification
REHABILITATION BY HEALTH SECTOR
AND MULTIDISCIPLINARY TEAM

 RECONSTRUCTION
 Setting up of shelter
 Health, food, and facilities in
the campus
 Education
 Training of
people/students/volunteers
 SHELTER MANAGEMENT PLANS:
 Nurse can act as shelter managers
 Listen to the victims
 Encourage victims to overcome the crisis
 Provide the basic resources. like food, water etc
 Provide compassion and dignity to the victim.
REHABILITATION BY HEALTH SECTOR

 Community cleanup efforts

 Teaching Proper Hygiene
 Alert For Environmental Health Hazards
 Home Visits
 Fallow up care
EXAMPLES OF RECOVERY …
 Restore essential services
 Community rehabilitation

 Counseling

 Temporary housing

 Financial support or assistance

 Health and safety information

 Long-term medical care

 Physical restoration/re-construction

 Public information

 Conducting economic impact studies

 EVALUATION
 Equipment Review

 Debriefing

 Review of Plans

 Documentation

 Education and Training

 Rehabilitation

 Restoration Function

 Safety Assessment

 Emotional Impact

 Recovery Process

 Research Opportunities
WHAT THE NURSES SHOULD
KNOW
NODAL AGENCY AND
ORGANIZATION
DISASTER
 Natural disaster
 Drought and drought relief
 Air accidents
 Railway accident
 Chemical disasters
 Biological disasters
 Nuclear disaster
NODAL MINISTRY
 Ministry of home affair
 Ministry of agriculture
 Ministry of civil aviation
 Ministry of railways
 Ministry of environment
and forests
 Ministry of health
 Dept. of atomic energy
CORE COMPETENCIES IN DISASTER
NURSING TRAINING
 Ethical and legal issues, and decision making;
 Care principles;

 Nursing care;

 Needs assessment and planning;

 Safety and security;

 Communication and interpersonal relationships;

 Public health; and

 Health care systems and policies in emergency

situations
(WHO, 2008)
TOPICS THAT MUST BE COVERED
BY DISASTER NURSING TRAINING
 Basic life support
 System and planning for settings where nurses
work
 Communications (what to report and to whom)

 Working in the damaged facilities and with

damaged equipment
 Safety of clients and practitioners

 Working within a team (understand each

member’s role and responsibility)
 Infection control

 Mental and psychosocial support

(WHO, 2006)
“Human history becomes more and more a race between education
and catastrophe.”
HG Wells
The Outline of History, Ch 15
TAKE HOME
MESSAGE

Nursing workforce are the integral part of

disaster management team. They should work
with confidence command , co –ordination and
control with the effective use of communication
skill in the affected community.
 
 SALUTE
THE HEROS OF MUMBAI TERRORIST ATTACK